Q: What is a hernia?
A: A hernia is a bulge of an organ through a weak area or hole in muscle.
Q: What causes a hernia?
A: Hernias are caused by an increase in abdominal pressure, which can cause an organ to bulge through a defect in muscle. Some hernias are congenital, meaning the weakness in the muscle has been there since birth. Others are caused by intense physical activity including heavy lifting and sports that involve quick twisting of the legs at full speed, such as soccer, hockey, lacrosse, baseball, football and running. Health factors such as prior surgeries, obesity and smoking can increase your risk for a hernia.
Q: How will I know if I have a hernia?
A: It depends on the kind of hernia you have. Some hernias are painless and you may only see a bulge under your skin. This is especially common in inguinal (groin) and ventral hernias.
For other types, you may experience discomfort or pain in the area of the hernia. Patients will commonly complain of a nagging discomfort associated with activities, prolonged standing or straining. Generally, hernia pain will disappear when lying down.
However, some hernias have more severe symptoms – for example, severe hiatal hernia sufferers may experience heartburn, nausea, vomiting, difficulty swallowing, chest pain and more. Hiatal hernias are generally only detected during an X-ray, CT scan or endoscopy. If you have any of these symptoms and suspect you have a hernia, contact your physician immediately.
Q: Are hernias dangerous?
A: Generally, hernias are not life-threatening. However, in the most severe cases, untreated hernias can cause death. Life-threatening situations related to a hernia may occur if the blood supply to the intestines becomes compromised resulting in necrosis or gangrene of the intestines, which would require emergency surgery. If you’ve been diagnosed with a hernia, we recommend getting it fixed as soon as possible so that you may resume your normal activities.
Q: How do I treat a hernia?
A: Most hernias should be repaired upon diagnosis. Occasionally, a surgeon may recommend that a hernia not be repaired if the risks to the patient outweigh the potential benefit. However, there are no medications to treat hernias, and they will not repair themselves without surgery.
Hernias can be repaired with conventional open surgery or minimally invasive surgical techniques. Open surgical repairs involve making a large incision over the top of the hernia. Generally, the recovery with an open hernia repair is longer and more painful than a minimally invasive (also known as laparoscopic) repair.
During a laparoscopic procedure, surgeons use special, slender instruments and a video camera lens inserted through several small incisions in the skin, eliminating the need for a large incision. Patients undergoing a minimally invasive hernia repair can anticipate a shorter hospital stay, less postoperative pain and a quicker return to normal activities. Other benefits of laparoscopic hernia repair include fewer infections and a decreased likelihood of hernia recurrence. Luckily, most hernias can be fixed with a laparoscopic procedure.
Many hernias are repaired with a synthetic material called mesh, which is extremely strong and durable but flexible and soft like fabric. It is used to fix the defect or hole in the tissues. Most patients are not aware of the presence of their mesh.
Ventral hernias larger than three centimeters in size and incisional hernias are generally repaired with mesh. Inguinal hernias are also usually repaired with mesh due to the dramatically reduced risk of hernia recurrence compared to a sutured mesh repair. Groin hernia repairs can also be performed with mesh, because those fixed without mesh are associated with far greater pain. Hiatal hernias will often be repaired with the use of a biologic mesh. The use of a biologic mesh at the site of the hole in the diaphragm reduces the likelihood of hernia recurrence.
Patients with asymptomatic hernias may elect to observe their hernias. The likelihood of requiring an emergency operation in an asymptomatic patient is low enough that this may be a safe strategy. However, a small number of patients who undergo this treatment strategy will require an emergency operation. Due to the fact that hernias do not resolve on their own, this strategy is only used in patients who wish to temporarily postpone hernia repair or others who are too ill to undergo an elective operation.
Patients with multiple hernia recurrences or more complicated hernias may benefit from an abdominal wall reconstruction. This involves advancing the muscles from the side of the abdomen to close the hernia defect. In many cases, a biologic mesh may be used as an adjunct to the muscle advancement. This type of repair is often called a “separation of components” hernia repair. The recovery is significantly longer than a laparoscopic repair, so this technique is generally reserved for only the most complex hernia repairs.
Q: How can I prevent a hernia?
A: The best way to prevent a hernia is to avoid adding abdominal pressure. Avoid activities that may strain your abdominal muscles, such as heavy lifting. If you are overweight, losing weight can help. Cigarette smoking has also been associated with an increased risk for the development of hernias.